Provider Demographics
NPI:1447536792
Name:MAXWELL, DAVID ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANDREW
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-0271
Mailing Address - Country:US
Mailing Address - Phone:704-279-0626
Mailing Address - Fax:704-279-0344
Practice Address - Street 1:110A EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138
Practice Address - Country:US
Practice Address - Phone:704-279-0626
Practice Address - Fax:704-279-0344
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4413103TC1900X, 251S00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No251S00000XAgenciesCommunity/Behavioral Health